Pre operative nursing care
The nursing admission should obtain both objective and subjective data about the patient and should assess whether the patient is eligible for treatment. Subjective data involves patients experience about the disease or condition in question, for example pain. (WHO, 2010) reveals that hernia is non tender and is painless unless it is strangulated. On the other hand objective data involve the clinical assessment that health care worker make against the patient. This may include height, age, sex, weight, vital signs as well as other risk factors for hernia such as smoking. However, no preoperative patient assessment is complete without evaluating respiratory system function, clinical examination and appropriate laboratory testing (Freebairn et. al, 2005). Similarly , Palymbo ,et al (2010) describe that the preoperative pathway of elderly patients with inguinal hernia need to be assessed based on cardiovascular and respiratory conditions, as well as ,diseases like diabetes. Hypertension, smoking and marginal vascular ailment require to be tested with hindsight. This information helps the doctors prepare for a comprehensive treatment.
The main purpose and necessity of obtaining base line data is to guide in the treatment process. This involves assessment of the risk factors. Some of the factors that lead to occurrence of inguinal diseases include gender, age and family background (Jansen et. al, 2009). Besides, before surgery, if a full diagnosis has not been made the patient is admitted to the hospital so that the necessary diagnostic investigations can be made. Information relating to the patients vital signs and other health indicators is obtained. This is useful particularly after surgery because such information will be used as a comparative data for measuring the patient’s progress. Moreover, quite often the patient may have other conditions apart from the one he is undergoing surgery that may complicate the surgery. This information will further guide the surgeon to ensure the optimal conditions before the operation process (Viljoen &Uys, 2006).
Within the preoperative period the nurse need to observe various ethical and legal issues. One of the ethical and legal requirements of the patient care is the informed consent. Informed consent involves various elements which include, review of the patient’s conditions, availability of therapeutic options including right to refuse treatment, review of material risks and potential complications and benefits from both medical and the patients perspectives (Luis, 2005). This is after the nurse has assessed the difficulty of the hernia repair before making the decision to operate. The nurse should consider whether the hernia is recurrent, very large and irreducible and whether the patient is obese. In Taylor’s case the nurses should assess whether he is ready for repair of his right inguinal hernia through informed consent.
Another ethical issue is the disclosure. WHO (2003),explain that any information about the patient’s condition belong to the patient and must be communicated to the patient; in most cases in the presence of the family and away from other patients. The extent of disclosure is affected by factors such as the severity of complication, the likelihood of complications to occur and the patient’s information preferences. Ideally, the surgeon tailors information to the needs and circumstances of the patient (Adedeji et. al, 2009). It is therefore imperative for the nurses to explain to Taylor about the possible complications of repairing the right inguinal hernia.
Post operative wound management
Although the key aims of wound management are to minimize physical trauma to the patient, nurses should prevent microbial invasion and ensure patient’s comfort (Pukki, Tekkanen & Halonen, 2010). Wound assessment entails measuring the size of the wound, its color, determining presence of swelling around the wound and others. This assessment helps doctors determine whether the wound is healing or infected and facilitates proper measures to help the patient. At times, drugs administered to the patient may not be effective. Wound assessment thus helps the doctor change the drugs so as to ensure that the wound heals as soon as possible. Surgeons do not usually assess the infection of the wound after hernia repair since the patient is discharged from the hospital under an out patient based program. Therefore, wound abscess drainage is usually performed in emergency rooms several days after discharge without achieving any control (Manuel & Gil, 2005).
The nurses should assess the size of the wound
This is important since it determines whether the wound is localized or increasing in size. The size of the wound, dimension whether length or breadth should be measured with plastic ruler and disinfected appropriately (Collier, 2007).
The nurses should assess risk factors such as smoking or obesity which affect wound healing.
It is important to assess the patient as a whole as this assist in the planning and evaluation of care (Gottrup et. al, 2008). According to Crisp and Taylor(2009),a person who is obese and is undergoing surgery stand a higher incidence of post operative hematomas and seromas that may delay the healing period of the wound. Taylor is an obese person hence his wound may take long to heal. Besides, he is a heavy smoker, a factor that further slows the wound healing process.
The caring nurses should also assess the amount and color of exudates of the patient’s wound
The color and the amounts of exudates from the wound determine the kind of treatment to be used against such wounds. According to Brown and Edwards (2008), a yellow wound has a non viable necrotic tissue which creates room for bacterial growth and such growth must be removed. In this case the purpose of treatment is cleansing of wound continually to remove non viable tissue and also to absorb excessive drainage. An absorption dressing such as calcium alginate may be used to address the yellow type of wound. Similarly, Taylors wound was oozing with yellow discharge and probably it could be infected with bacteria. According to Bupas Health Information Team (2009), one of the most complications of wound after surgery are infections and this means that the bacteria have started to grow in the wound. Because there is possibility of wound bleeding, the nurses should asses the possibility of bleeding of Taylors wound and address this accordingly (Brygel, 2005).
Nurses should assess the tissue around the wound
The type of tissue within a wound should be noted to determine whether it is a necrotic tissue or not. If it is necrotic, it should be removed to facilitate healing and reduce the risk of infections (The pursuit of excellence, 2005).
Aseptic technique is a procedure performed typically in a disinfected environment to prevent instances of contamination with harmful bacteria. This technique minimize the transfer of micro organism to the wound.A sepsis can be achieved only when sterile objects and fluid are allowed to come into contact with the wounds. But this is difficult to achieve because pathogens are resident throughout various areas of the body (Gillespie & Fenwick, 2009). Despite the fact that asepsis is hard to achieve the caring nurses should try as much as possible to ensure that the Taylors wound is free from contamination.
Disinfection or sterilization
This principle eliminates all micro-organism from the infected area or objects. Facilities and provisions especially medical tools such as surgical instruments can be uncontaminated by gas, heat and chemical disinfectants. Medical practitioners ought to ensure that all equipments are decontaminated by using different chemicals and indicators used in determining the sterility of equipments (Advameg, 2010).Hence the nurses in the operation room should ensure that equipment used for the repair of the Taylors right inguinal hernia are sterile.
Personal hygiene i.e. hand washing
Because health care workers handle different equipment in the course of their work, there are high chances of the hands becoming contaminated with micro-organisms.. Hand washing reduces the incidences of nosocomial infections since most infections are spread by the hands of staff.It also remove transient micro organism and prevent transfer to another patient (Daniels & Rees,2007)
Non- touch technique
This is a technique of preventing micro-organisms which may be present on equipment or hands from being introduced into the patient’s wounds. The health care workers attending to Taylor’s repair of the right inguinal hernia should change the dressings without directly touching the wound or without touching any other surface that might contaminate it. According to Burkitt, Quick and Reeds (2007), protection can be given by wearing gloves but the less the wound is touched the better. This is the principle of non touch technique and applies particularly when aseptic conditions are less than ideal
Use of antimicrobial
Anti microbial agents reduce the number of micro-organism at the incision site by inhibiting their growth and development. Broad spectrum antibiotics should be selected if the type of bacteria causing infection is unknown. The level of resistance or toxicity of the selected microbial agent should be considered. Chances of appropriate microbial agents can be improved when cytological specimens of the wound fluid undergo gram staining to distinguish gram negative and gram positive bacteria. The result directs the initial therapy (Dunning, 2006).
The process of wound healing is complex and dynamic since the wound environment changes with the changing health status of individual (Keast & Orsted, 2007). Besides these factors, massive infection is the main cause of the wound breakdown. Cigarette contains nicotine and carbon monoxide. Nicotine is a vasoconstrictor, reducing the size of the blood vessel. This reduces nutritional blood flow to the skin leading to reduced healing of the injured tissue. Besides, it decreases erythrocytes propagation and oxygen carriage to the affected tissue. Moreover, carbon monoxide affects oxygen transport and metabolism. It combines with hemoglobin to form a steady compound called oxyhaemoglobins which is not straightforwardly broken thus impairing oxygen transportation (Rayner, 2006). Additionally , obesity also affect wound healing in the sense that it increases the work load of the heart since there is reduce supply of oxygenated blood to the tissue. Moreover, obesity cause increased pressure in the veins which makes it difficult for vital oxygen and nutrients to reach the cells slowing down the healing process (Joyce & Jan, 2006).
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